中华解剖与临床杂志
中華解剖與臨床雜誌
중화해부여림상잡지
Chinese Journal of Anatomy and Clinics
2014年
2期
117-120
,共4页
许恩喜%张恒柱%严正村%佘磊%董伦%王晓东%李育平
許恩喜%張恆柱%嚴正村%佘磊%董倫%王曉東%李育平
허은희%장항주%엄정촌%사뢰%동륜%왕효동%리육평
Kawase入路%硬膜下%锁孔%内镜%解剖
Kawase入路%硬膜下%鎖孔%內鏡%解剖
Kawase입로%경막하%쇄공%내경%해부
Kawase approach%Intradural%Keyhole approach%Endoscope%Anatomy
目的 探讨神经内镜模拟颞下锁孔硬膜下Kawase入路手术可行性和适应证.方法 成人尸头湿标本8具(16侧),模拟神经内镜颞下锁孔硬膜下Kawase入路,观察内镜下显露的最大视野,辨识弓状隆起、三叉神经、岩浅大神经、岩上窦等解剖结构,标识Kawase三角的边界,测量不同磨除范围下Kawase三角的各边长,显露小脑膜切迹间隙、脑干腹外侧、上中岩斜区、中下岩斜区交界处及其邻近结构.结果 弓状隆起最高点到棘孔、岩浅大神经裂孔、岩浅大神经与下颌神经的交点;三叉神经压迹外侧缘的最短距离分别为(22.90±2.34) mm、(14.05±2.09) mm、(24.94±1.98) mm、(23.49±2.38) mm; Kawase三角磨除面积为(3.04±0.47) cm2,扩大磨除Kawase三角面积为(3.7±0.69) cm2,平均增加了0.66 cm2的面积.结论 经神经内镜颞下锁孔硬膜下Kawase入路避免了对脑膜中动脉的损伤,保留了岩浅大神经.适合处理位于小脑幕切迹间隙,上、中岩斜区,中、下岩斜区交界处,部分桥小脑角脑干腹外侧广泛区域的肿瘤、动脉瘤等病变.
目的 探討神經內鏡模擬顳下鎖孔硬膜下Kawase入路手術可行性和適應證.方法 成人尸頭濕標本8具(16側),模擬神經內鏡顳下鎖孔硬膜下Kawase入路,觀察內鏡下顯露的最大視野,辨識弓狀隆起、三扠神經、巖淺大神經、巖上竇等解剖結構,標識Kawase三角的邊界,測量不同磨除範圍下Kawase三角的各邊長,顯露小腦膜切跡間隙、腦榦腹外側、上中巖斜區、中下巖斜區交界處及其鄰近結構.結果 弓狀隆起最高點到棘孔、巖淺大神經裂孔、巖淺大神經與下頜神經的交點;三扠神經壓跡外側緣的最短距離分彆為(22.90±2.34) mm、(14.05±2.09) mm、(24.94±1.98) mm、(23.49±2.38) mm; Kawase三角磨除麵積為(3.04±0.47) cm2,擴大磨除Kawase三角麵積為(3.7±0.69) cm2,平均增加瞭0.66 cm2的麵積.結論 經神經內鏡顳下鎖孔硬膜下Kawase入路避免瞭對腦膜中動脈的損傷,保留瞭巖淺大神經.適閤處理位于小腦幕切跡間隙,上、中巖斜區,中、下巖斜區交界處,部分橋小腦角腦榦腹外側廣汎區域的腫瘤、動脈瘤等病變.
목적 탐토신경내경모의섭하쇄공경막하Kawase입로수술가행성화괄응증.방법 성인시두습표본8구(16측),모의신경내경섭하쇄공경막하Kawase입로,관찰내경하현로적최대시야,변식궁상륭기、삼차신경、암천대신경、암상두등해부결구,표식Kawase삼각적변계,측량불동마제범위하Kawase삼각적각변장,현로소뇌막절적간극、뇌간복외측、상중암사구、중하암사구교계처급기린근결구.결과 궁상륭기최고점도극공、암천대신경렬공、암천대신경여하합신경적교점;삼차신경압적외측연적최단거리분별위(22.90±2.34) mm、(14.05±2.09) mm、(24.94±1.98) mm、(23.49±2.38) mm; Kawase삼각마제면적위(3.04±0.47) cm2,확대마제Kawase삼각면적위(3.7±0.69) cm2,평균증가료0.66 cm2적면적.결론 경신경내경섭하쇄공경막하Kawase입로피면료대뇌막중동맥적손상,보류료암천대신경.괄합처리위우소뇌막절적간극,상、중암사구,중、하암사구교계처,부분교소뇌각뇌간복외측엄범구역적종류、동맥류등병변.
Objective To discuss the indications and feasibility of Kawase approach in the intradural subtemporal keyhole by using neuroendoscope.Methods Simulated surgery via intradural subtemporal keyhole modified Kawase approach with assist from rigid neuroendoscope was performed on eight adult cadaver heads fixed by formalin,the maxin maximum viewer of the approach was observed.The endoscope,through the subdural space,was used to observe the anatomic marks of the middle cranial fossa,including arcuate eminence,trigeminal nerve,greater superficial petrosal nerve,superior petrosal sinus,the the space of tentorial notch and petroclival region.The surgical field was measured by the comparison of different milling range of petrous apex,and the anatomical structure through this approach was analyzed.Results The shortest distances from the highest point of arcuate eminence to foramen spinosum,greater superficial petrosal nerve hiatus,the intersection of greater superficial petrosal nerveand mandibular nerve,the outside edge of the trigeminal impression were (22.90 ± 2.34) mm,(14.05 ± 2.09) mm,(24.94 ± 1.98) mm,and (23.49 ± 2.38)mm,respectively.Various anatomical triangles in the lateral wall of the cavernous sinus and the middle cranial fossa could be distinctly exposed,among which the Kawase's triangle milling area was (3.04 ± 0.47) cm2,and the area after the maximum milling of the petrous apex under the trigeminal impression was (3.7 ± 0.69) cm2,the area increase 0.66 cm2.Conclusions The intradural subtemporal keyhole Kawase approach avoids injury the middle meningeal artery and the greater superficial petrosal nerve.It can expose wide surgical area,including the incisure of tentorium of cerebellum,the superior and middle petroclival region,the junctional area of the middle and inferior petroclival region,brainstem ventrolateral.Through the natural gap and grinding the petrous apex bone,it can treat lesions in these areas.
